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  • Title: Occult constrictive pericardial disease emerging 40 years after chest radiation therapy: a case report.
    Author: Goten C, Murai H, Takashima SI, Kato T, Usui S, Furusho H, Saeki T, Sakagami S, Takemura H, Kaneko S, Takamura M.
    Journal: BMC Cardiovasc Disord; 2018 May 31; 18(1):107. PubMed ID: 29855329.
    Abstract:
    BACKGROUND: The main etiology of constrictive pericarditis (CP) has changed from tuberculosis to therapeutic mediastinal radiation and cardiac surgery. Occult constrictive pericardial disease (OCPD) is a covert disease in which CP is manifested in a condition of volume overload. CASE PRESENTATION: A 60-year-old patient with a history of thoracic radiation therapy for non-Hodgkin's lymphoma (40 years earlier) was transferred to our hospital for treatment of repeated congestive heart failure. For a preoperative hemodynamic study, pre-hydration with intravenous normal saline (50 mL/hour) was used to manifest the pericardial disease and prevent contrast-induced nephropathy. The hemodynamic study showed a right ventricular dip-plateau pattern and discordance of right and left ventricular systolic pressures during inspiration, which was not seen in the volume-controlled state. These responses were concordant with OCPD. A pericardiectomy, aortic valve replacement, and mitral and tricuspid valve repair were performed. Postoperatively, the heart failure was controlled with standard medication. CONCLUSIONS: This case revealed a volume-induced change in hemodynamics in OCPD with severe combined valvular heart disease, which suggests the importance of considering OCPD in patients who had undergone radiation therapy 40 years before.
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